Figure 3: Coronary angiography – critical stenosis of right coronary artery
Transthoracic echocardiography performed immediately after CAG showed
hyperdynamic left ventricle with severe hypokinesis of inferior and
inferolateral wall. There was chaotic movement of rounded mass in left
ventricle with complete flail of anterior mitral leaflet (figure 4a). The mass did
not prolapse into left atrium. Short axis view confirmed the mass to be
ruptured posteromedial papillary muscle (PMPM) (figure 4b) causing severe
acute eccentric posterolateral directed jet of Mitral regurgitation into non-
dilated left atrium (4c, d). It was difficult to establish whether it was partial or
complete rupture of PPM considering suboptimal TTE study as it was performed in hemodynamically unstable patient with respiratory distress.
A B